World Neurosurg
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Primary hypothyroidism can cause both hyperprolactinemia and pituitary hyperplasia. The degree of hyperprolactinemia is generally modest, and rarely do prolactin concentrations exceed 100 ng/mL (4.34 nmol/L). This combination of hyperprolactinemia and pituitary gland enlargement might raise suspicion for a prolactinoma or a nonfunctioning adenoma limiting the ability of hypothalamic dopamine to inhibit prolactin production, the so-called "stalk effect." ⋯ Primary hypothyroidism can cause hyperprolactinemia, and prolonged disease may lead to pituitary hyperplasia. However, a marked elevation of prolactin should raise suspicion to investigate additional etiologies for hyperprolactinemia. Our case exemplifies a dual etiology for hyperprolactinemia and pituitary hyperplasia caused by both hypothyroidism and macroprolactin. This knowledge is invaluable for clinicians to avoid unnecessary management with dopamine agonists and/or surgery. This patient's prolactin was 323 ng/mL (14.06 nmol/L). Before our case, the highest prolactin in a hypothyroid patient reported in the literature was 253 ng/mL (11.0 nmol/L).
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For the treatment planning of a patient with a middle cerebral artery (MCA) trunk aneurysm, understanding the anatomic relationship among the aneurysm, branching vessels, and lenticulostriate arteries (LSAs) is important. We aimed to demonstrate the branching-vessel anatomy related to an MCA trunk aneurysm using 3-dimensional (3D) angiography. ⋯ We have identified a clinically important anatomic relationship between the MCA trunk aneurysm and branching vessels, including the LSAs. EFCB aneurysms show a close relationship with the LSAs. Pretreatment identification of the origin of the LSAs is important to obviate any perforator injury in EFCB aneurysms.
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Extended endoscopic transsphenoidal surgery (EETS) is a safe and effective treatment for many suprasellar craniopharyngiomas, including those with third-ventricle involvement. Craniopharyngioma entirely within the third ventricle (purely intraventricular type), however, is generally regarded unsuitable for treatment with EETS. ⋯ Selected patients with purely intraventricular craniopharyngioma can be treated effectively and safely with EETS. Those with inferior extension in the interpeduncular fossa and anterior displacement of the chiasm may be suitable candidates.
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Despite recent technological advances, direct approaches to the posterolateral incisural space remain surgical challenges. The choice of the operative route depends on the exact location and extent of the target lesion as well as individual preferences. The extreme lateral infratentorial supracerebellar approach to treat pathologies located in the ambient cistern and posterior incisural space is a technically feasible route in selected cases. In this cadaveric study, we demonstrate the benefits of endoscope-assisted microsurgical maneuvers using the extreme lateral supracerebellar infratentorial approach. ⋯ Direct visualization of the posterior and posterolateral incisural space avoids retraction of the occipital lobe and damage to the deep venous complex. The extreme lateral infratentorial supracerebellar corridor is effective for approaching the posterolateral mesencephalic junction and the posterior incisural space in selected cases. Endoscope-assisted microsurgery can improve visualization and minimize parenchymal retraction, which should enhance surgical control.
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The sellar spine is a rare, bony growth that typically arises from the dorsum sellae. Few cases have been described in the literature thus far, and most are asymptomatic and incidentally found. We describe the case of a 19-year-old female in whom a sellar spine was noted to be associated with pituitary glandular deformation and symptomatic optic apparatus compression. ⋯ Recognition of a sellar spine can be elusive, and removal of a symptomatic one may be technically challenging. It is important to consider this entity in the differential diagnosis of a patient with headaches and bitemporal visual deficits.